BluePeak Advisors Case Study
BluePeak guided Neighborhood Health Plan of Rhode Island through a complex Medicare bid process to successfully submit a compliant and competitive CY2026 DSNP bid.
Executive Summary
In late 2023, Neighborhood Health Plan of Rhode Island partnered with BluePeak to navigate the complexities of transitioning from a Medicare Medicaid (MMP) Demonstration Plan to a Dual Special Needs Plan (DSNP) for Plan Year 2026, which required submitting a compliant bid to the Centers for Medicare and Medicaid Services (CMS) in June 2025.
Facing challenges such as unfamiliarity with bid requirements and lack of internal resources, Neighborhood relied on BluePeak’s expertise to ensure financial and operational stability while maintaining competitive market positioning. BluePeak provided comprehensive support, including market analysis, financial evaluation, strategic product design guidance, and bid accuracy assurance.
BluePeak’s deep expertise and tailored approach were instrumental in overcoming Neighborhood’s unfamiliarity with bid requirements and lack of internal resources. As a result, Neighborhood successfully submitted its CY2026 bid on time, meeting all regulatory requirements, and continues to receive support from BluePeak in preparing for the DSNP launch, enhancing their product team’s implementation capabilities.
The Challenge
Background
In 2022, Neighborhood partnered with BluePeak to address the operational and regulatory challenges associated with Medicare compliance. As part of this collaboration, Neighborhood sought BluePeak’s assistance in transitioning from an MMP Demonstration Plan to a DSNP. This transition necessitates the annual submission of a compliant bid to the Centers for Medicare and Medicaid Services (CMS). Despite CMS providing guidance and process documents, the bid submission is a complex process that requires expertise in both technical aspects and financial and industry acumen to understand the downstream implications of bid decisions. Without proper understanding and consideration, organizations risk significant financial, operational, and compliance issues. BluePeak’s comprehensive understanding of Medicare compliance and bid submission processes provided Neighborhood with the necessary expertise to navigate complex regulatory landscapes.
Objective
The objective was to achieve a successful dual special needs plan bid submission that ensures financial and long-term operational stability of the plan design while securing competitive positioning within a highly volatile market. BluePeak aimed to not only ensure a successful bid submission but also to fortify Neighborhood’s market positioning through strategic insights and operational stability.
Methodology
BluePeak employed a comprehensive methodology to support Neighborhood by providing hands-on assistance across all organizational levels. This approach involved not only instructing but also educating key leadership and individual contributors on the process, importance, and implications of bid decisions.
BluePeak’s methodology was centered around empowering Neighborhood’s team through education and strategic guidance, ensuring long-term capability development. By utilizing a team approach, BluePeak ensured consistent and experienced guidance in delivering both technical and strategic direction for Neighborhood’s bid submission.
Additionally, BluePeak leveraged the expertise of Neighborhood’s actuarial partner to maintain financial and actuarial integrity in meeting submission requirements.
Solutions Implemented
1
Market Comparison Study
- Evaluated existing market research and assumptions to assess best offerings for plan viability and make recommendations.
- Created a comparison grid of all competitor plan offerings utilized industry experience and publicly available resources to pressure test and clarify competitive plan designs.
2
Actuarial RFI Process
- Issued a request for information (RFI) for consideration of four actuarial firms in the review and ultimately selection of a partner to provide actuarial review and certification of Neighborhoods CY2026 bid.
- Ensured the selection of a partner that aligned with Neighborhood’s strategic goals.
3
Financial Evaluation/Pro-Forma Support, Review and Feedback
- Provided strategic product design guidance using plan’s financial analysis and proforma reports to give guidance on both short- and long-term goals and objectives.
- Review available bid development data and narratives and make recommendations on best practices.
- Provide guidance on administrative cost allocation, efficiency, and opportunity within bid process.
- Worked collaboratively to support the organization’s efforts with their actuarial partner firm, ensuring a successful outcome by facilitating understanding and collaboration in the financial activities of bid preparation. This included translating issues and questions for clarity, posing additional inquiries, and engaging in other supportive activities.
4
Strategic Guidance on Product and Benefit Design
- Evaluated implications and risk associated with Fully Integrated Dual Eligible (FIDE) SNP only go to market strategy. Provided alternative product options to balance and protect membership base by offering a secondary Coordination Only DSNP plan due to uncertainty in Rhode Island’s approval process.
- Reviewed benefit design and supplemental benefit offerings to align with financial, regulatory and market needs.
- Worked with Neighborhood’s finance team, pharmacy team, Pharmacy Benefit Manager, and actuaries on bid versions, making recommendations for potential benefit changes or bid input to meet Neighborhood financial targets.
- Reviewed and consulted on resubmissions for any PBP changes due to National Average Benchmark Amount changes and/or CMS desk review changes.
- Supported narrative submissions required of bid process to articulate and position Neighborhood’s CY2026 product offering.
5
Bid Accuracy
- Provided real time plan benefit package (PBP) data entry support and quality assurance review against both regulatory and financial requirements of bid pricing tool (BPT).
- Supported review of operational and process issues related to feasibility of benefit design and product offerings to ensure go-to-market compliance.
- Provided project plan support for bid execution including submissions and responses by CMS to and through desk review, rebate reallocation and contract execution.
- Developed and completed a change list to ensure decisions were tracked when changes were made to documents for stakeholder visibility and monitoring impacts for ANOCs, etc.
6
Post-Bid Submission Support Activities
- Delivered organization wide training content to communicate and explain the CY2026 product offerings and benefits.
- Supported technical review and implementation of bid specific decisions to ensure accurate system configuration and benefit adjudication.
Results
Bid Outcome
CY2026 DSNP Bid Successfully Submitted
Compliant CMS bid delivered on time and positioned for competitive market entry.
Compliant CMS bid delivered on time and positioned for competitive market entry.
2
DSNP Contracts Submitted
(FIDE SNP and Coordination Only DSNP)
(FIDE SNP and Coordination Only DSNP)
0
CMS Desk Review Issues
Only routine clarifications and minor PBP language updates.
Only routine clarifications and minor PBP language updates.
Successful and compliant bid submission supporting Neighborhood’s transition to DSNP for CY2026.
With BluePeak’s strategic planning and execution support, Neighborhood successfully submitted a compliant CY2026 DSNP bid, including both a FIDE SNP and Coordination Only DSNP contract. CMS identified no issues during the desk review process beyond routine clarifications and minor PBP language updates. BluePeak continues to support Neighborhood in preparing for the CY2026 DSNP launch while strengthening the organization’s internal product team capabilities for cross-functional implementation.
”BluePeak’s holistic approach, combining strategic foresight with operational expertise, positions them as an invaluable partner for Medicare Advantage plans seeking to navigate complex bid processes and achieve sustainable growth.
Conclusion
Unlike many actuarial firms that focus solely on financial acuity and consulting firms with a focus on operations, BluePeak provides a practical and tactical model that enables organizations to understand the downstream implications of their bid submissions, addressing both potential risks and opportunities through a partnership with an actuarial firm. A successful bid requires strategic insight into both short- and long-term organizational stability and the feasibility of operationalizing bid decisions. Many organizations lack the experience, capacity, or structure to execute these aspects effectively, positioning BluePeak as a valuable partner, particularly for new or small to mid-size Medicare Advantage plans facing resource, cost, and efficiency challenges in a competitive market.
